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10 Months baby won't wait for letdown, ready to quit

I never thought I would say this, but I am at my wits end and ready to quit. My goal was to BF until 2 years but we just hit 10 months and I don't think I can go much longer. The baby has lost all patience for initiating letdown. She won't stay latched long enough to initiate and gets frustrated because milk doesn't come out instantly. I have to use my pump to initiate letdown or she will go without nursing. It started 2 months ago with only the bedtime feeding, then went to last 2 feedings of the day, and now it's every feeding except the first one in the morning. It makes me feel like she hates breastfeeding and I am torturing her trying to force her to breastfeed.

We saw a an IBLC LC who recommended getting her tongue and lip clipped but my husband just doesn't support that at 10 months so that's not an option.

Is there any hope, if I keep using the pump to initiate letdown, she will ever nurse on her own again? It's so stressful for both of us, it is impacting our relationship. It's been going on for 2 months.

She gets 3 bottles a day M-F (slowest flow available) but nurses exclusively on weekends and evenings.

Re: 10 Months baby won't wait for letdown, ready to quit

Is your letdown particularly slow? (and is this a new thing?) How long does it take for you to let down when you pump? Is your milk production overall in question, or is it for sure only an issue with slow letdown?

Fennel is suggested in the Womanly Art specifically for milk release issues. But it's an offhand mention with no further detail, maybe you could discuss that with your IBCLC? What about relaxation techniques etc. to you can try to speed up letdown...

What do you think of the tt suggestions? Have you had baby assessed by anyone else besides your IBCLC? (Someone who could actually do the procedure? )If you agree that tt may be part of the problem I do not see how a tt clip now as opposed to earlier is objectionable? Generally there is very little risk and great reward to treatment if tt is causing breastfeeding (or any other) issues. For several decades tt was not recognized as a barrier to breastfeeding, (because babies who could not nurse due to tt were bottle fed just like the vast majority of babies were) and tt was only seen as possibly an issue with speech and tongue movement concerns that adversely affected eating, frenotomies were routinely not done until baby was about a year old. In other words, it is not as if 10 months is somehow too late for tt release. While there is a question of degree, either baby has tongue tie or does not, and if baby does, and a medical professional is willing to perform a frenotomy, then frenotomy is an appropriate treatment. A release may or may not fix the problem, but if a professional thinks it might, it is odd to have the procedure completely off the table.

Dragging out the pump every time you nurse would certainly kill spontaneity…What else have you tried… ‘instant reward” techniques, hand expression, suck training, nipple shield, at the breast supplementer?

Is baby eating solids? Is baby being given cups of water or anything else to drink?

Re: 10 Months baby won't wait for letdown, ready to quit

Meg,
I don't think my letdown is slow, it takes less than one minute on the pump and about the same when she nurses. But she will only latch and suck for about 10 seconds before getting mad and popping off. Then, with the on and off and crying my letdown can take up to 3 minutes because she just won't stay latched. This behavior started very abruptly at 8 months (2 months ago). I am pretty sure my overall production is decent, not great, but just enough. Though I often have to pump after feedings as she won't wait for a second letdown, leaving some milk in the breast. Her transfer during a weighed feeding was excellent though.

I do take moe milk special blend as recommended by the LC. She nurses great in the morning because my breasts are full and she gets at least a little milk right from the start. I can't seem to get any kind of letdown from hand expression. What is suck training?

My husband is against the clip because her tongue doesn't look tied. The LC emailed her photos to a local Dr and he simply replied starting he could do the procedure, not saying she needed it. I think if I could get a Dr to tell him she needs it, it might be an option. But because she nurses fine sometimes it is hard to believe it is biological issue and not a behavioral or other issue. The idea that we might put her through the procedure (which at her age means either general anesthesia or restraints) and not see a difference is scary.

She does eat solids twice a day. About 2 ounces of fruit in the morning an hour after nursing and 3 ounces of finger veggies 30 minutes after nursing in the evening. I have noticed a significant uptick in her interest in solids the last couple of weeks.

Oh, and she has started recently wanting to switch breast as soon as the milk flow slows then goes back and do forth, back and forth the rest of the session. Not very soothing or conducive to nursing in public. This is new behavior and shows up during the afternoon and evening feeds similar to the letdown impatience.

I almost feel like she has forgotten how to breastfeed.

Thank you for your help! I am very committed to breastfeeding and really do wish it to be a positive experience for us both!

Re: 10 Months baby won't wait for letdown, ready to quit

And this might be a dumb question, but she has been nursing 6 times a day for the last 5 months. Is it possible this behavior shows up when she just isn't that hungry? I am not sure because she latches, would she not latch at all if not hungry?

The reason I thought about this is because she almost never does this the first 2 feedings of the day, which are spaced about 3 hrs apart usually. But I offer every 2 hours the rest of the day (I started doing this when she lengthened her afternoon nap around 8 months old because I didn't want her to have an empty tummy for her nap. Maybe I should not offer so soon, unless of course she shows signs she is hungry. Just a thought.

Re: 10 Months baby won't wait for letdown, ready to quit

And this might be a dumb question, but she has been nursing 6 times a day for the last 5 months. Is it possible this behavior shows up when she just isn't that hungry? I am not sure because she latches, would she not latch at all if not hungry?

I think this is a good question. Yes, this behavior could be due to baby not being hungry or not wanting to nurse at the moment -but then, why is baby not hungry? -I think nursing 6 times a day is pretty little already... If you are finding your baby is nursing better if you wait longer, obviously that is good- On the other hand, such infrequent nursing might harm production... It's a tough one. I would suggest, maybe try nursing only on cue for a couple days and see, maybe pumping a bit if baby does not nurse much?

I would also suggest, IF you are mostly spoon feeding baby pureed baby food, try doing finger foods she picks up instead, and/or foods baby can hold in her fist and suck/bite/chew instead (like a soft spear of fruit, steamed carrot sticks, that kind of thing) This allows baby to learn to actually eat (bite, chew, move the pieces about in her mouth with her tongue,) which is what solids 'introduction' is all about, instead of simply slurping down purées. If you read about baby led solids aka baby led weaning, that is basically what I am getting at. I think babies will sometimes 'overeat' if they are only or mostly spoon fed purees or over mashed foods. Calories and nutrition wise, breastmilk is much more important into baby than is baby food, so solids introduction is for teaching eating, not filling tummy. That is also why water and juice is best avoided in the first year assuming baby is still breastfeeding.

Suck training is exactly what it sounds like, training a baby to suck correctly. It is something your IBCLC would teach you to do if the problem is that baby is not triggering a letdown due to not sucking correctly.

You know I completely forgot that the clip procedure itself would be a much bigger deal at this age. That is certainly something to consider. But your IBCLC must be suggesting it for some reason. I would suggest talking these concerns over with her or getting a second opinion maybe from another IBCLC? I wonder if you would try contacting a tongue tie/breastfeeding expert-Dr. Murphy, Dr. Kotlow?

I think your doctor is unlikely to be willing to a surgical procedure for which he sees no benefit, however, maybe you could clarify that with him?

I almost feel like she has forgotten how to breastfeed

Yes I am sure this is frustrating, however, I think this is not the case, as baby nurses fine or at least ok part of the time? I wonder if it is more as if baby could perhaps be gently encouraged to comfort nurse more? Have you tried the ideas for that in this kellymom article? http://kellymom.com/bf/concerns/child/back-to-breast/

Re: 10 Months baby won't wait for letdown, ready to quit

Meg,
Well I tried to feed more based on cues today and it didn't help. First two nursings of the day were great. Then, starting with that third nursing its like a different baby. Refuses to wait for letdown. I just don't get it. I swear, the behavior is like night and day. I had to use the pump for all subsequent sessions to illicit letdown before she would stay latched. Tis is after much tears from both parties.

We don't do puréed just finger foods and I even limit the amounts on those (her gross motor skills are outstanding and she can shovel the food in like crazy!).

She seems to suck OK waiting for letdown, her issue is she is only willing to wait about 10 seconds, and if she's not getting milk by them it's all over.

I try really hard to encourage comfort nursing, but she prefers her pacifier. I had over active letdown and she had bad reflux for the first 4 months so she came to love the paci. I give every opportunity possible for her to comfort nurse. Sometimes, my my husband reads her a book she will comfort nurse for about 5 seconds, then off, then on again, then off again. Not sure if this on/off is technically considered comfort nursing.

I do think our IBLc emailed our photos to Dr Kotlow, we are awaiting a response.

Is this behavior common with bottle preference? Do babies with terrible bottle preference ever "come around"? One last thing, this behavior started suddenly when she switched from going to daycare to staying at our house with my Mom. Before this switch she never received bottles at home. Could it be confusing for her to get bottles in the same location she used to only get the breast? Just wracking my grain trying to figure this out. Two months of feedings in tears has my whole family wondering how much longer we can keep this up.

Re: 10 Months baby won't wait for letdown, ready to quit

Well, I wish I were more help...this is a really tricky situation!

What about instant reward...dribbling a little expressed milk onto your nipple? Or can you hand express to illicit a letdown, rather than having to pump every time?
I DO think this behavior sounds like what Dr. Jack Newman calls "flow confusion" which is a form of nipple confusion. Actually I think Newman would say flow confusion is simply a better term for nipple confusion. Baby is used to fast, easy, basically unstopable flow of bottles, and so gets frustrated with what is normal at the breast.

As far as being home with your Mom as opposed to day care, well, some weird stuff affects babies so...maybe? But even if that IS it, what could you do about that? Since baby tales bottles fine (I presume) It's somethign to consider...maybe it would help to know when exactly she is giving baby the bottle, what she does before, how she prepares baby etc, does she sing a song, walk baby around while baby has the bottle…whatever...maybe by mimicking what your mom does when bottle feeding you can get baby more interested in breastfeeding?

What I would also suggest is to talk to your mom about how baby is being given a bottle. She may be having baby self feed the bottle at this age(?) but if possible it may be helpful to use paced bottle feeding techniques esp. as far as bottle positioning, rate of flow, and pauses are concerned. One of the purposes of using this technique for bottle feeding is to hopefully prevent or limit flow confusion. See linked info below.

Maybe she could even try making baby suck longer on the bottle before tipping it to where baby can get milk, to mimic normal letdown(?)

Do babies with terrible bottle preference ever "come around"?

Yes. Nursing vacations can be one helpful technique if you have not tried that yet. In a real pinch I have heard of nipple shields being helpful sometimes as well.

Since this is clearly happening at specific feedings and not others, I would also suggest again looking at any OTHER differences between the “good” sessions and the ‘bad." Everything from positioning, lighting, noises, distractions, if you are wearing a perfume or deodorant you do not have on earlier...
Sometimes it helps to brainstorm wiht someone else all the things that are different, even things that sem as if they could have nothing to do with breastfeeding.

Re: 10 Months baby won't wait for letdown, ready to quit

I am sad to report things have gotten worse for us. She refused to breastfeed in the middle of the night last night (latched for 15-20 seconds then gave up, sat up, reached for her pacifier on the table, leaned against me and went back to sleep). Then, this morning she fussed when the milk didn't come after about 20 seconds, and because I was fearing this (since it was our only good feeding left) I got so stressed then even though she would latch again a couple of times for 20 seconds or so the milk just wasn't coming. I am heartbroken. Mornings were our bonding time when I would nurse her and snuggle for 30 minutes or so before going to work. I noticed this morning that her suck was so weak, she could barely even keep the latch. And poor thing, she will latch anytime I sit with her and expose my breast so it seems as if she wants to breastfeed, but then she comes off crying within a few seconds so something isn't working right. She would prefer her pacifier and an empty stomach for some reason.

We have switched bottles, did the delay before letting her have the milk, and are doing paced bottle feeding. I did a nursing vacation last week for 4 days and that didn't seem to help (in fact by day 2 she was refusing even more feedings than before the nursing vacation).

We are seeing the lactation consultant again today, but I am feeling so sad and scared that our breastfeeding days are coming to an end. I am so committed to this - it is hard to accept defeat.

Re: 10 Months baby won't wait for letdown, ready to quit

Hi Kadiebug -Im having the same issue! My LO is 8 months and is progressing well with solids. She will not wait for let down and so i have to pump to start it off then latch her on, which lasts for less than a minute. I switch sides for faster flow and she will feed again for about a minute. I pump the rest off and its very slow flow and I might get another ounce perhaps but its slow. Im not exclusively pumping and its an absolute pain. Ive just ordered myself an electric pump as Im pumping at every feed. The problem is that I don't have enough milk for a full feed as I only get 3 ounces in total across both sides so I am collecting up the left overs from previous pumping sessions and this is even more of a nightmare chilling them in the fridge then mixing together :-S

The problem has progressed like this:

- always been a quick feeder and gradually got faster and faster (3 mins per side around 4/5 mths)
- started to offer both sides and would take about 5 mins in total and started to go four hours between feeds around 4.5-5mths
- starting to roll and sit / moved into own room (into new cot) and started baby led weaning around 5.5mths
- started to latch / unlatch around 5.5-6mths (around the time she was learning to crawl)
- eating lots of food by 6 mths so assumed she didnt want her feeds
- she struggled a bit with feeding and was unhappy around the time her first two teeth came in which is understandable
- started waking in the night more about 7mths until i started topping her up with expressed milk
- now Im expressing and feeding more milk once she came off the breast and she took it and started to sleep through the night again
- now probably used to fast flow teats and even refusing morning milk which used to let down instantly

HELP! will I ever get back my breastfeeding? I would be happy if I could improve my supply and have enough for each feed

I would also suggest bedsharing again (at least part of the night) to encourage comfort nursing.

It sounds as if your baby was not nursing very long or very frequently even before the introduction of solids. If weight gain remained good, this might indicate you had a very fast flow of milk. How else would baby get enough nursing so little? So, has something happened that may have caused a reduction in milk production? Starting birth control, some other medication?

baby led weaning around 5.5mths-

Can you explain what you mean? Different people use this term to mean different things. Do you mean, baby led weaning as a solids introduction technique as described in the book Baby Led Weaning (baby self feeding "regular" food -so, no or very little purees, baby cereals, or spoon feeding?) Or something else?

Because I wonder exactly how much your baby is eating, solids wise. Also, is your baby drinking anything besides breastmilk? When breast refusal appears shortly after the introduction of solids, the first thing I want to rule out is a too fast push on solids causing baby to be filled up with something besides breastmilk.

Another thing that can lead to “early onset weaning” (I just made that term up) is something called “triple nipple syndrome.” (That one I did NOT make up, it is a term coined by a pediatrician.)

Basically, this is used to describe what seems to happen when a breastfeeding baby is given pacifiers and bottles and over time, baby learns to equate bottles with food and pacifier with comfort and no longer identifies mammas breast as the ‘go to’ place for both.

- started waking in the night more about 7mths until i started topping her up with expressed milk

It is normal for a baby to want to nurse for food and comfort at night. Yes it is a very tiring thing, but normal. Breastfeeding typically goes best if bottles and pacifiers are kept to a minimum-only for separations or if baby requires supplements.

Also, 3 ounces form both breasts is not bad per pump session. How are you defining a "full feed?" A baby who is exclusively breastfeeding needs about 30 ounces of breastmilk a day, spaced out over about 10 sessions per day. That averages to 3 ounces per feed. Of course, it is usually more like a baby takes one ounce some feedings, 5 at others, and everything in between.

Kellymom has good articles about pumping, increasing production, and what is normal output when pumping.